Perceived stigma drives depression in lung cancer

Greater levels of perceived stigma were related to greater levels of depression in a recent study of persons with stage II, III, or IV non-small cell lung cancer (NSCLC).

Given the strong association between lung cancer and tobacco use, lung cancer is often viewed as a preventable disease. Many patients—even those who have never smoked—blame themselves or feel others are blaming them for contracting the illness, according to Paul B. Jacobsen, PhD, of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida.

Previous research has demonstrated that people with lung cancer are at an increased risk for depressive symptomatology. Jacobsen and Moffitt colleague Brian D. Gonzalez, MA, hypothesized that greater perceived stigma would account for variance in depressive symptomatology above and beyond that accounted for by relevant variables. To test their theory, the investigators had 95 outpatients who were receiving chemotherapy for stage II-IV NSCLC complete a demographic questionnaire and self-report measures that assessed perceived stigma, depressive symptomatology, and other psychosocial variables. Clinical factors were evaluated by means of medical chart review.

As Jacobsen and Gonzalez reported in Psycho-Oncology (2012; 21[3]:239-246), perceived stigma and depressive symptomatology were positively associated: 38% of the surveyed patients suffered from depression, which is consistent with the rate of 21% to 44% found in other studies documenting depression in lung cancer patients.

However, the team also found that perceived stigma accounted for significant unique variance in depressive symptomatology above and beyond that accounted for by relevant clinical, demographic, and psychosocial factors. Greater levels of perceived stigma were related to greater levels of depression, and greater levels of depression were related to more avoidant coping, poorer social support, and more dysfunctional attitudes.

These findings suggest that psychotherapeutic approaches might be able to target perceived stigma to alleviate or prevent depression among persons with lung cancer.